Home > InterAct Event Registration Form InterAct Event Registration Form Name of Event Event Description Date of Event Time of Event Event Location - Street Address City State Zip Code Purpose of Event Community Engagement and OutreachDonation DriveFundraising Event Frequency One TimeMonthlyQuarterlyIndefinite Event Website Event Facebook Event Twitter Contact Name Contact Email Contact Telephone Use of InterAct Logo? YesNo How Will Logo Be Used? Request for InterAct Materials InterAct MaterialsDomestic Violence MaterialsSexual Assault Materials Additional Materials (please list) Are You Reuqesting An InterAct Booth At Event? YesNo Are You Requesting A Representative from InterAct At Event? YesNo Time Speaker Needed I have read and understood the above guidelines and registration and ensure InterAct's name will be properly used, funds will be handled and accounted for in a responsible manner, fundraising will be conducted in a method that is consistent with the public image of InterAct and that all those associated with the event or promotion will act in accordance with all municipal and federal laws. I understand that at anytime InterAct can withdraw its permission if it feels its reputation is at risk or any other liability or challenge arises. Signature Date
